It’s not a “Slipped” Disc… (Part 1 of 3)

More often than not, we have patients come into the office that tell us they’ve been diagnosed with a “slipped disc”. This is commonly in reference to the intervertebral disc and generally addressing a potential disc bulge or herniation. We have discussed disc injuries a lot in the past, so we won’t get into that, but, technically speaking, the disc does not “slip”. The disc is adhered to the vertebral endplates of the vertebrae above and below. The outmost layer of the annulus fibrosus is attached to the endplates via what are called Sharpey’s fibers. The disc is held in place in the front and back by the Anterior Longitudinal Ligament (ALL) and the Posterior Longitudinal Ligament (PLL), respectively. There are cases in which the ALL and PLL can be ruptured, but these cases are usually caused by some form of trauma. Regardless, the term “slipped disc” is not exactly accurate. However, “slipped vertebrae” is a much more accurate description of a specific spine injury. These are called spondylolisthesis.

A spondylolisthesis is typically diagnosed via radiographs but can also be diagnosed via orthopedic testing. Generally, the vertebrae can “slip” either forward or backward in relation to the vertebrae below it. In the case where it slips forward, this is called an anterolisthesis and conversely, a retrolisthesis when slipping backward.

There are varying degrees of severity of spondylolisthesis and it even has its own grading system. The Meyerding Classification divides the superior endplate of the vertebra below into 4 quarters. The grade depends on the location of the posteroinferior corner of the vertebra above in relation to the vertebra below.

- Grade I: 0-25%

- Grade II: 26-50%

- Grade III: 51-75%

- Grade IV: 75-100%

- Grade V: >100%

So how does this happen? There are few different causes. They can be congenital, caused by fractures, or repetitive stress. They can be a result of unstable, degenerated intervertebral disc, which causes excessive shear forces to be exerted on the posterior elements of the vertebrae, resulting in stress fractures. As a result, there can be excessive motion of the superior vertebra in relation to the inferior vertebra. This is what is visualized on radiographs.

Next week, we will dive a bit deeper into specific causes as well as active and inactive, stable and unstable, and pending spondylolistheses.

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